Liver transplantation using cavoportal hemitransposition— a life-saving procedure in the presence of extensive portal vein thrombosis

Olausson, Michael; Norrby, J; Mjörnstedt, L.; Lidén, Hans; Friman, Styrbjörn

doi:10.1016/s0041-1345(00)02494-5

Cited by 22 publications

(13 citation statements)

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“…The surgical technique used to restore portal vein inflow in patients with grade 4 PVT was only described in six studies . To be more specific, the surgical technique was reported for 46 cases, most of them involving cavoportal hemitransposition (19/41) 46%.…”

Section: Resultsmentioning

confidence: 99%

“…). Pooling data from ten studies that reported on mortality by grade of PVT, only three of the 128 patients with grade 1 PVT (2.3%), 8 of 137 with grade 2 (5.8%), and 3 of 35 with grade 3 (8.6%) were dead 30 days after LT. On the other hand, mortality rose to 9 out of 33 (27%) ( P < 0.001) among patients whose PVT extended to the SMV (grade 4). Only, three studies reported on 1‐year mortality by extent of splanchnic vein thrombosis, describing a mortality of 15 out of 76 patients with a partial PVT (22%) and 19 out of 45 (42%) with a complete PVT ( P = 0.011).…”

Section: Resultsmentioning

confidence: 99%

“…Complete obstruction of the PV and/or extension to the SMV can be treated by means of various venous jump graft reconstructions or PV arterialization . Nonanatomical solutions, particularly portocaval hemitransposition (PCHT), do not cure portal hypertension, which complicates patients’ postoperative course, with a negative fallout on their quality of life in approximately 50% of patients . Among 49 patients who underwent portocaval hemitransposition in the published cohorts , 20% had episodes of variceal bleeding, 58% had persistent ascites, and 26% developed renal dysfunction after LT.…”

Section: Discussionmentioning

confidence: 99%

“…Nonanatomical solutions, particularly portocaval hemitransposition (PCHT), do not cure portal hypertension, which complicates patients’ postoperative course, with a negative fallout on their quality of life in approximately 50% of patients . Among 49 patients who underwent portocaval hemitransposition in the published cohorts , 20% had episodes of variceal bleeding, 58% had persistent ascites, and 26% developed renal dysfunction after LT. In the most recent series , the 1‐year pooled mortality rate was 40% (6/16).…”

Section: Discussionmentioning

confidence: 99%

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Mortality in liver transplant recipients with portal vein thrombosis - an updated meta-analysis

et al. 2018

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Portal vein thrombosis (PVT) is the most common thrombotic event in liver transplant (LT) recipients, but its impact on mortality after LT has been analyzed in heterogeneous cohorts with mixed results. To conduct a meta-analysis on the impact of PVT on post-LT survival. A systematic search was conducted on studies (published from January 1986 to January 2018) that reported 30-day and 1-year mortality after LT of PVT patients. Four hundred twenty-seven articles were reviewed and 44 were included. Among 98 558 LT, 7257 (7.3%) involved patients with PVT. The mean quality was high (7.1 on the Newcastle-Ottawa scale). The 30-day pooled mortality rate was higher for patients with PVT (64/490; 13%) than for others (259/3357; 7%) (OR 2.29; 95% CI 1.43-3.68; P < 0.0001). One-year mortality was likewise higher in recipients with (853/6302; 13.5%) than in those without PVT (7476/75 355; 9.9%) (OR 1.38; 95% CI 1.14-1.66; P < 0.0001). Heterogeneity wasn't significant (I 46% and 65%). Patients whose PVT was complete had a higher 30-day pooled mortality rate (OR 5.65; 95% CI 2-15.96; P < 0.0001), and a 1-year mortality rate (OR 2.48; 95% CI 0.99-6.17; P = 0.38) than patients with partial PVT. PVT is common in LT candidates and it is associated with higher short- and medium-term mortality after LT.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Mortality in liver transplant recipients with portal vein thrombosis - an updated meta-analysis

et al. 2018

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“…For patients with diffuse thrombosis of the splanchnic venous system, portal inflow via cavoportal hemitransposition has been proposed in deceased donor whole liver transplantation . In living donor liver transplantation, cavoportal hemitransposition is rarely indicated because a partial liver graft cannot tolerate the high systemic blood flow through the inferior vena cava.…”

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confidence: 99%

Restoration of portal flow using a pericholedochal varix in adult living donor liver transplantation for patients with total portosplenomesenteric thrombosis

et al. 2014

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In total portosplenomesenteric thrombosis patients, cavoportal hemitransposition (CPHT) is indicated but rarely applicable for adult-to-adult (A-to-A) living donor liver transplantation (LDLT) because partial liver graft requires splanchno-portal inflow for liver graft regeneration. If intra-& peri-pancreatic collaterals draining into pericholedochal varix were present, pericholedochal varix may provide splanchnic blood flow to the transplanted liver and also relieve recipient's portal hypertension. To date, however, there is no successful report using pericholedochal varix in liver transplantation (LT). We successfully performed Ato-A LDLTs using pericholedochal varix for those 2 patients. The surgical strategies are followings: (a) dissection of hepatic hilum to isolate left hepatic artery using for arterial reconstruction of implanted right lobe graft, (b) en-mass clamping of the undissected remaining hilum if we can leave adequate length of stump from the clamping site, and then hilum is divided, (c) delay the donor hepatectomy until the feasibility of the recipient operation is confirmed. Portal flow was established between the sizable pericholedochal varix (caliber > 1cm) and graft portal vein, but the individually designed approaches were used for each patients. Currently, they have been enjoying normal life on posttransplant 92 and 44 months respectively. In conclusion, enlarged pericholedochal varix in patients with totally obliterated splanchnic veins might be an useful inflow to restore portal flow and secure good outcome in A-to-A LDLT.

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Cavoportal Hemitransposition in Liver Transplantation: Toward a More Safe and Efficient Technique

2019

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Extended splanchnic venous thrombosis represents a challenge for the liver transplantation (LT) surgeon. In the absence of large venous tributaries, the cavoportal hemitransposition (CPHTr) and the combined liver‐intestinal or multivisceral transplantation are the only technical solutions. Because of the reported high morbidity and mortality rates due to infrequent use and a lack of standardization, the former technique has been almost abandoned by the transplant community. A newly designed technique of CPHTr is presented that is based on the combination of an inferior vena cava (IVC)–sparing hepatectomy and large laterolateral cavocaval and end‐to‐side cavoportal anastomoses separated only by a double vascular stapler line. This technique allows the splanchnic blood to be completely diverted toward the allograft and to eliminate low‐flow IVC areas, which possibly lead to complications. The modified CPHTr technique proposed here offers a valuable alternative to much more complex and invasive intestinal transplantation procedures.

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Liver transplantation using cavoportal hemitransposition— a life-saving procedure in the presence of extensive portal vein thrombosis

Cited by 22 publications

References 2 publications

Mortality in liver transplant recipients with portal vein thrombosis - an updated meta-analysis

Mortality in liver transplant recipients with portal vein thrombosis - an updated meta-analysis

Restoration of portal flow using a pericholedochal varix in adult living donor liver transplantation for patients with total portosplenomesenteric thrombosis

Cavoportal Hemitransposition in Liver Transplantation: Toward a More Safe and Efficient Technique

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